| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $134.90 | $134.90 | $151.36 | |
Medica
| Professional | $501.19 | $501.19 | $501.19 | |
Molina
| Professional | $58.88 | $58.88 | $58.88 | |
Quartz
| Facility | $93.33 | $199.53 | $199.53 | |
Quartz
| Professional | $173.78 | $501.19 | $501.19 | |
United
| Facility | $35.48 | $50.12 | $53.70 | |
United
| Professional | $35.48 | $50.12 | $81.28 |